Our Body, Our Health: Qualitative Metadata

The National Pain Strategy notes the importance of addressing pain in minority populations to reduce health disparities. One such population is female refugees who have been victim to female genital cutting (FGC) --- which is known to cause sexual pain. The objective of the proposed research is to collect empirical data to (1) inform the conceptualization of sexual pain and other outcomes among Somali women living in Minnesota who have experienced FGC, (2) promote healthcare practices that minimize sexual pain, and (3) develop decision- making tool(s) and education seminars driven by study findings. The majority of Somali girls undergo infibulation when originally cut, which involves stitching the vaginal opening shut. Deinfibulation (i.e. opening the circumcision/infibulation scar) may decrease pain and is necessary before vaginal birth. It is recommended before labor and delivery; however, many patients wait until labor and delivery to undergo deinfibulation –thus increasing a risk in tears. Little is known about how sexual pain and sexual function are impacted by the timing of deinfibulation. To better understand sexual pain in relation to FGC, we will rely upon conceptual models that utilize a biopsychosocial approach, integrating biological, psychological, and cultural considerations. These models include fear-avoidance, endurance, and resilience. We will partner with a community-based organization (SoLaHmo) and two large medical clinics serving Somali American women to conduct 75 qualitative interviews, 300 computer assisted surveys of Somali-American married women 18-45 years who have experienced FGC to accomplish the following aims: Aim 1: Qualitatively investigate sexual pain characteristics and meaning ascribed to sexual pain. Aim 2: Establish reference levels using descriptive statistics to quantify sexual pain characteristics (presence, frequency, intensity), sexual function, pain responses (fear avoidance, endurance, resilience), and moderator variables (acculturation and shared decision making) in this population. Aim 3: Among women who have vaginally delivered one or more babies, determine if sexual pain characteristics and sexual function are associated with the timing of deinfibulation with first child. Aim 4: Among women reporting sexual pain in Aim 3, determine if pain responses (fear avoidance, endurance, resilience) are associated with sexual pain and sexual function, and whether these associations are modified by degree of acculturation --- while adjusting for timing of deinfibulation. The long-term goal is to identify mechanisms that will lead to better pain management in this population. Completion of these novel study aims will generate information to develop evidence-based and culturally- sensitive medical and psychological interventions for women who have undergone FGC.

《国家疼痛战略》（National Pain Strategy）指出，关注少数群体的疼痛问题对减少健康差异具有重要意义。其中一个群体为曾遭受女性外阴残割（female genital cutting, FGC）的女性难民，已知该行为会引发性交疼痛。本拟开展研究的目标为收集实证数据，以达成三项任务：其一，明确明尼苏达州境内曾遭受FGC的索马里女性群体的性交疼痛及其他结局的概念框架；其二，推广可减轻性交疼痛的医疗实践方案；其三，基于研究结果开发决策工具及教育研讨会。大多数索马里女孩在初次接受外阴残割时会接受锁阴术（infibulation），即缝合阴道开口。拆锁阴术（deinfibulation，即切开割礼/锁阴术瘢痕）可缓解疼痛，且为阴道分娩的必要前提。临床建议在分娩前完成拆锁阴术，但许多患者直至分娩时才接受该手术，从而增加了撕裂风险。目前关于拆锁阴术的时机对性交疼痛及性功能的影响尚不明确。为更深入理解与FGC相关的性交疼痛，本研究将采用整合生物学、心理学及文化因素的生物-心理-社会概念模型，相关模型包括恐惧回避模型、耐力模型与韧性模型。本研究将与一家社区组织（SoLaHmo）及两家服务索马里裔美国女性的大型医疗诊所合作，针对75名曾遭受FGC的索马里裔美国女性开展定性访谈，并针对300名年龄在18-45岁之间的已婚索马里裔美国女性开展计算机辅助问卷调查，以达成以下研究目标：目标1：定性探究性交疼痛的特征及其被赋予的意义。目标2：通过描述性统计建立参考基准，以量化该群体的性交疼痛特征（存在情况、发生频率、疼痛强度）、性功能、疼痛反应（恐惧回避、耐力、韧性）及调节变量（文化适应与共同决策）。目标3：针对经阴道分娩过一名或多名子女的女性，探究性交疼痛特征与性功能是否与首胎分娩前拆锁阴术的时机相关。目标4：针对目标3中报告存在性交疼痛的女性，探究疼痛反应（恐惧回避、耐力、韧性）是否与性交疼痛及性功能相关，且在调整拆锁阴术时机的前提下，文化适应程度是否会对上述关联产生调节作用。本研究的长期目标为明确可改善该群体疼痛管理的作用机制。完成上述创新性研究目标，将为曾接受FGC的女性开发循证且兼具文化敏感性的医疗与心理干预方案提供依据。